One Year of Medicaid Managed Care in South Texas Yields Greater Access to Health Providers

The Gilmer Mirror

Mar 06, 2013 | 2006 views | 0 | 12 | |

One Year of Medicaid Managed Care in South Texas Yields Greater Access to Health Providers, Better Care, Fewer Complaints and Virtually No Impact on Access to Pharmacies

Austin, TX – One year ago this week, Texas implemented Medicaid Managed Care (MMC) in South Texas, improving health care access, yielding billions in savings to Texas taxpayers and reducing health care costs by 15 percent. Data from the implementation period compiled by the Texas Health and Human Services Commission (HHSC) also shows virtually no impact (just0.7percent) on South Texas pharmacies.

“Managed care has reduced Medicaid costs and has saved Texas $1.5 billion of taxpayer money, while improving healthcare access in South Texas,” said Bill Hammond, President and CEO of the Texas Association of Business (TAB). “And despite claims to the contrary, the data shows virtually no impact on South Texas access to pharmacy services under Medicaid Managed Care.”

“The expansion of Medicaid Managed Care has proven to be the right decision for Texas patients, providers and taxpayers,” said Hammond. “We are improving access to healthcare providers, savings billions of dollars and improving the health and lives of Texas citizens all at the same time.”

HHSC data on the Hidalgo Service Delivery area shows during the year since MMC was expanded to South Texas:

- Primary care physician access increased over a 9-month implementation period by 35.5% for the STAR program (pregnant women and children) and increased 38.5% for the STAR+PLUS program (aged, blind and disabled).

- Enrollment increased 3% for the STAR+PLUS program and remained steady in STAR.

- Pharmacy access has remained steady in South Texas for over 6 months in the STAR and STAR+PLUS programs. There were 830 pharmacies in the HHSC Hidalgo Service Area in June 2012 and 824 in November 2012, a change of just 0.7%.

- Complaints decreased more than 35% since the beginning of the program. Just 143 justified complaints from the nearly 400,000-health plan members were filed in the last quarter for all MMC health plans and all products.

- Clean claims payments to acute providers within 30 days exceeded the 98% standard set by Texas HHSC.

Prior to last March, 350,000 Medicaid recipients throughout Texas, and especially in the Rio Grande Valley, were excluded from MMC programs as the result of 2003 legislation. Between 2003 and 2011, MMC became a proven success in improving care and saving taxpayer money throughout the parts of the state where it was implemented. Using that MMC success model, the 2011 Texas Legislature voted to enhance the quality of care for Medicaid enrollees in South Texas and, at the same time, stop needlessly spending taxpayer dollars by implementing Medicaid Managed Care throughout the entire state. Medicaid recipients are getting better care and the state is saving billions of dollars.

In 2009, TAB released a report entitled Expanding Medicaid Managed Care in Texas: The Right Dosage for Texas Recipients, a comprehensive primer on the benefits of expanding MMC in the State of Texas, specifically in the Rio Grande Valley. Hammond was quoted as saying that “The businesses and employers of Texas want to see increases in the access and quality of health care services available to their employees, to their families and to the entire workforce….“not only would Texas be saving business and taxpayer dollars, but most importantly, we would be increasing the access and quality of health care services to thousands of Texas citizens.”

This statement could not ring any truer, as the expansion of Medicaid Managed Care has served more Medicaid members without any increases in managed care costs and without more tax dollars from Texas businesses.

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Founded in 1922, the Texas Association of Business is a broad-based, bipartisan organization representing more than 3,000 small and large Texas employers and 200 local chambers of commerce.